FAQs: Frequently asked questions

What is Credentialing?

Credentialing — also called medical or physician credentialing — is a detailed process that reviews doctors’ qualifications and career history including their education, training, residency and licenses, as well as any specialty certificates. Credentialing must be completed upon the hire or enrollment of a new doctor and on regularly afterwards to abide by the standards set forth by regulatory and accreditation organizations such as the National Committee for Quality Assurance (NCQA) and The Joint Commission (TJC).

Does Credsimple do provider enrollment?

No. Our service does not include enrollment. We are focused on primary source verification for medical staff as described above. And while we don’t do enrollment at all, the accurate provider data that comes out of the primary source verification work that CredSimple does is extremely useful to the enrollment process (and we’d welcome an introduction to your medical credentialing department).

Are CredSimple’s credentialing verifications NCQA Compliant?

Yes. CredSimple is an NCQA certified CVO. NCQA awarded us a score of 100% across all 10 elements of credentials verification.

What is a CVO?

A CVO or Credentials Verification Organization is a third-party organization that gathers data and verifies the credentials of doctors and other healthcare practitioners. Health plans, hospitals and other entities that provide healthcare services to consumers may delegate credentialing responsibilities to a CVO to maximize operational efficiency.

Why is an automated CVO better than my in-house team?

In addition to saving time by streamlining the credentialing process, CredSimple enables clients to use the data generated from credentialing to add value to other segments of a health plan or hospital, such as the care management system or the provider directory. Utilizing CredSimple’s software in conjunction with our data and services lowers the total cost of credentialing, saves you time and increases your efficiency and operational functionality.

By plugging in directly to primary source databases and automating the data transfer, we eliminate manual tasks–improving credentialing turnaround time by 94% and decreasing risk of errors. CredSimple automates all the tasks that don’t require a human touch/brain, freeing your team up to focus on more important matters, rather than repetitive manual tasks (your team will thank you). With our NCQA certification, you automatically score 100% for your credentialing section on your next NCQA survey, something your team cannot guarantee.

CredSimple allows you to stay on top of your credentialing process. This prevents the development of backlogs and allows you to scale easily and efficiently without adding additional headcount.

How long do verifications take to complete?

CredSimple’s standard turnaround time is five days or less.

Yes, you read that right, five days or less.

CredSimple maintains up-to-date NCQA and JCAHO compliant primary source databases. Thus, many of CredSimple’s verifications take place in real time as providers are added to the CredSimple platform. Additional verifications, such as education and NPDB queries, can take up to two business days.

Since CredSimple seeks to ensure complete data accuracy, some data may also require review before being released. Applications containing medical staff verifications including background checks, verification of insurance coverage and affiliation history, and collection of reference letters will be completed within five days.

At any time, our clients can see the status of each part of a provider’s credentialing application or monitoring.

Do you provide other services beyond credentialing?

Yes! We can provide background checks, verification of insurance coverage and affiliation history, and collection of reference letters. In short, CredSimple can satisfy all NCQA and Joint Commission requirements for primary source verifications and data collection, delivering to clients the complete package of information ready for your review committee.

Can I purchase CredSimple services separately?

Yes. In fact, we customize solutions for most of our clients to meet their specific credentialing and provider data needs. Request a demo for more information.

How does CredSimple’s continuous monitoring work?

CredSimple maintains up-to-date primary source databases that are compliant to credentialing standards (including NCQA and JCO). After each update to any database, CredSimple checks your roster against all new data about license expirations, sanctions or malpractice cases, alerting you to any problems with your provider network and keeping your providers informed and your patients safe.

How does CredSimple capture provider data?

CredSimple captures provider data in three ways:

CAQH: A provider with a CAQH application with up-to-date attestations can have their data captured and loaded directly into CredSimple from CAQH.

CredSimple Application: Administrators can invite providers to add their information to CredSimple using our application, an easy-to-use online form that captures the required provider information to complete a credential event.

Add Providers Button: The CredSimple management dashboard includes an Add Providers Button that administrators can use to capture provider data for a single provider or a large batch of providers, making it easy to manage and capture the information from hundreds or thousands of provider files.

CredSimple is an NCQA certified CVO that provides credentialing as a software-as-a-service platform, allowing health plans and hospitals to manage credentialing more effectively with a very lean team. In a traditional CVO, work processes are done manually, which increases the cost and turnaround time. At CredSimple, our work processes are automated and/or enabled by technology. CredSimple’s platform automatically manages applications, seamlessly completes primary source verifications (PSV), and performs ongoing monitoring.